i. · 2019-06-06 · director koetting, seconded by director richardsonlowry, moved to recess - the...
TRANSCRIPT
Minutes of the meeting of the Quality and Patient Safety Committee of the Board of Directors of the Cook County Health and Hospitals System held Thursday, April 18, 2019 at the hour of 10:00 A.M. at 1950 W. Polk Street, in Conference Room 5301, Chicago, Illinois.
I. Attendance/Call to Order
Chair Gugenheim called the meeting to order. Present: Chair Ada Mary Gugenheim and Directors Mary Driscoll, RN, MPH; Mike
Koetting (Substitute Member) and Mary B. Richardson-Lowry (Substitute Member) (3)
Board Chair M. Hill Hammock (ex-officio) and Director David Ernesto Munar
Telephonically Present: Patrick T. Driscoll, Jr. (Non-Director Member)
Absent: Directors Heather M. Prendergast, MD, MS, MPH and Layla P. Suleiman
Gonzalez, PhD, JD (2) Additional attendees and/or presenters were:
Linda Follenweider – Chief Operating Officer,
Correctional Health Trevor Lewis, MD – John H. Stroger, Jr. Hospital
of Cook County Jeff McCutchan – General Counsel Iliana Mora – Chief Operating Officer, Ambulatory
Services
John O’Brien, MD – Chair, Department of Professional Education
Deborah Santana – Secretary to the Board John Jay Shannon, MD – Chief Executive Officer Ronald Wyatt, MD – Chief Quality Officer
II. Public Speakers
Chair Gugenheim asked the Secretary to call upon the registered public speakers.
The Secretary responded that there were none present.
III. Report from Chief Quality Officer
A. Regulatory and Accreditation Updates
Dr. Ronald Wyatt, Chief Quality Officer, provided a brief update on regulatory and accreditation matters. He stated that he attended the Annual Leadership Forum at The Joint Commission yesterday. At the Forum, they focused on leadership, specifically relating to professionalism, and sterile processing.
B. Metrics (Attachment #1)
Dr. Wyatt provided an overview of the metrics. The Committee reviewed and discussed the information.
C. Diabetes Care Update (deferred to May)
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IV. Action Items
A. Approve appointments and reappointments of Stroger Hospital Department Chair(s) and Division Chair(s)
There were none presented for the Committee’s consideration.
B. Executive Medical Staff (EMS) Committees of Provident Hospital of Cook County and John H. Stroger, Jr. Hospital of Cook County
i. Receive reports from EMS Presidents ii. Approve Medical Staff Appointments/Reappointments/Changes (Attachment #2)
Dr. Trevor Lewis, President of the EMS of John H. Stroger, Jr. Hospital of Cook County, provided his report. He stated that, at the recent EMS meeting, they received presentations from Obstetrics/Gynecology and the Operating Room Committee.
Director Driscoll, seconded by Director Koetting, moved to approve the Medical Staff Appointments/Re-appointments/Changes for John H. Stroger, Jr. Hospital of Cook County. THE MOTION CARRIED UNANIMOUSLY.
Dr. Valerie Hansbrough, President of the EMS of Provident Hospital of Cook County, was unable to attend the meeting. The Committee considered the proposed Provident Hospital medical staff actions presented for their consideration.
Director Driscoll, seconded by Director Koetting, moved to approve the Medical Staff Appointments/Re-appointments/Changes for Provident Hospital of Cook County. THE MOTION CARRIED UNANIMOUSLY.
C. Minutes of the Quality and Patient Safety Committee Meeting, March 22, 2019
Director Driscoll, seconded by Director Koetting, moved to accept the Minutes of the Quality and Patient Safety Committee Meeting of March 22, 2019. THE MOTION CARRIED UNANIMOUSLY.
D. Any items listed under Sections IV, V and VI
V. Recommendations, Discussion/Information Items
A. Strategic Planning Discussion:
• Graduate Education (Attachment #3) - Approve proposed clinical training affiliation agreements (Attachment #4)
Dr. John O’Brien, Chair of the Department of Professional Education, provided an overview of the presentation on Graduate Education and related action items, which included information on the following items:
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V. Recommendations, Discussion/Information Items
A. Strategic Planning Discussion (continued) • Overview of the Department of Professional Education • Impact 2020 Update – Status and Results • History of Medical Training in the U.S. • Moving Away from a Service-Based Residency Model • Final Deliverables • Recruit Outstanding Medical Students • Origin of Medical Students for the Incoming Class • Train in High Quality Residencies • Train in High Quality Fellowships • Retention of Graduates • Retention of Graduates in the Last Three Years • Rotator Programs • Cost Analysis • FY2020-2022 – The Future • Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis • FY2020-2022 Strategic Planning Recommendations • Action Items – Agreements for Review and Approval
During the review of the information relating to staffing, Dr. Shannon noted that Dr. O’Brien is the Designated Institutional Official for the organization’s training programs. Each of those training programs has a physician program director and supports within them. Director Richardson-Lowry requested a chart reflecting the positions within the Department of Professional Education and related training programs. During the discussion of the information regarding the origin of medical students, it was stated that 40% of the primary care physicians are from outside of the U.S. Director Richardson-Lowry requested information on the breakdown and how the organization compares to comparably sized institutions with similar focus. Director Richardson-Lowry suggested that, with regard to the work being done by staff to secure visas for residents, perhaps the administration should look into potential internal or external resources to assist. • Primary Care / Maternal Child Care (Attachment #5)
Iliana Mora, Chief Operating Officer of Ambulatory Services, provided an overview of the presentation on Primary Care / Maternal Child Care, which included information on the following items: • Overview of Ambulatory Health Centers • FY2018 Overview of Cook County Health (CCH) Patients Demographics • FY2018 Primary Care Visits • FY2018 Specialty / Diagnostic / Procedure Visit Volume • Impact 2020 Update – Status and Results • FY2020-2022: The Future – Environmental Scan of Market, Best Practices and Trends • Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis • FY2020-2022 Strategic Planning Recommendations
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V. Recommendations, Discussion/Information Items A. Strategic Planning Discussion (continued)
During the review of the information, Director Richardson-Lowry requested that a map be provided that includes a clear legend that reflects where CCH clinics and Federally-Qualified Health Centers (FQHCs) are located, and include the categories of services provided by CCH clinics versus the FQHCs. This will help the Board as they think strategically about where to move or not, and where there might be synergy or not. It will also inform their thinking with respect to marketing strategies, as well as any potentials around mergers and forecasting. Additionally, Director Richardson-Lowry stated that, with respect to the nomenclature relating to the maternal infant mortality rate, particularly amongst African Americans, the term “project,” was used. Project by definition has a start and an end. In an earlier conversation, Chair Gugenheim noted that, by having the mentality of it being a project, the organization did not get to the point where the systemic issues were addressed. As the organization moves towards addressing the systemic issues and maximizing the opportunities, she requested that the term “project” not be used. With regard to slide 34 of the presentation, in the category of Opportunities within the SWOT Analysis, Director Richardson-Lowry requested that the word “maternal” be included with the bullet on prenatal and pediatric patient base.
Director Driscoll, seconded by Director Koetting, moved to approve the proposed clinical training affiliation agreements. THE MOTION CARRIED UNANIMOUSLY.
VI. Closed Meeting Items
A. Medical Staff Appointments/Re-appointments/Changes B. Claims, Litigation and Quality and Patient Safety Matters C. Matters protected under the federal Patient Safety and Quality Improvement Act of 2005 and the
Health Insurance Portability and Accountability Act of 1996 D. Quality and Patient Safety Report
Director Koetting, seconded by Director Richardson-Lowry, moved to recess the open meeting and convene into a closed meeting, pursuant to the following exceptions to the Illinois Open Meetings Act: 5 ILCS 120/2(c)(1), regarding “the appointment, employment, compensation, discipline, performance, or dismissal of specific employees of the public body or legal counsel for the public body, including hearing testimony on a complaint lodged against an employee of the public body or against legal counsel for the public body to determine its validity,” 5 ILCS 120/2(c)(11), regarding “litigation, when an action against, affecting or on behalf of the particular body has been filed and is pending before a court or administrative tribunal, or when the public body finds that an action is probable or imminent, in which case the basis for the finding shall be recorded and entered into the minutes of the closed meeting,” 5 ILCS 120/2(c)(12), regarding “the establishment of reserves or settlement of claims as provided in the Local Governmental and Governmental Employees Tort Immunity Act, if otherwise the disposition of a claim or potential claim might be prejudiced, or the review or discussion of claims, loss or risk
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VI. Closed Meeting Items (continued)
management information, records, data, advice or communications from or with respect to any insurer of the public body or any intergovernmental risk management association or self insurance pool of which the public body is a member,” and 5 ILCS 120/2(c)(17), regarding “the recruitment, credentialing, discipline or formal peer review of physicians or other health care professionals, or for the discussion of matters protected under the federal Patient Safety and Quality Improvement Act of 2005, and the regulations promulgated thereunder, including 42 C.F.R. Part 3 (73 FR 70732), or the federal Health Insurance Portability and Accountability Act of 1996, and the regulations promulgated thereunder, including 45 C.F.R. Parts 160, 162, and 164, by a hospital, or other institution providing medical care, that is operated by the public body.”
THE MOTION CARRIED UNANIMOUSLY and the Committee recessed into a closed meeting.
Chair Gugenheim declared that the closed meeting was adjourned. The Committee reconvened into the open meeting.
VII. Adjourn
As the agenda was exhausted, Chair Gugenheim declared the meeting ADJOURNED.
Respectfully submitted, Quality and Patient Safety Committee of the Board of Directors of the Cook County Health and Hospitals System XXXXXXXXXXXXXXXXXXXXXX Ada Mary Gugenheim, Chair
Attest:
XXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary
Requests/follow-up:
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DRAFT – for 4/26/19 CCHHS Board of Directors Meeting
Requests/follow-up: Request: A request was made for a chart reflecting the positions within the Department of Professional
Education and related training programs. Page 3 Request: With regard to the statement that 40% of CCH primary care physicians are from outside of the
U.S., a request was made for a breakdown and how the organization compares to comparably sized institutions with similar focus. Page 3
Follow-up: A suggestion was made, with regard to the work being done by staff to secure visas for residents,
that perhaps the administration should look into potential internal or external resources to assist. Page 3
Request: A request was made for a map that includes a clear legend that reflects where CCH clinics and
Federally-Qualified Health Centers (FQHCs) are located, and include the categories of services provided by CCH clinics versus the FQHCs. Page 4
Request: With regard to slide 34 of the presentation, in the category of Opportunities within the SWOT
Analysis, a request was made that the word “maternal” be included with the bullet on prenatal and pediatric patient base. Page 4
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Cook County Health and Hospitals System Quality and Patient Safety Committee Meeting
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ATTACHMENT #1
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QPS Quality Dashboard
April 18, 2019
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3
45.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
HEDIS – Diabetes Management: HbA1c < 8%
%A1c<8 HEDIS 75th PCTL Source: Business Intelligence
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89.2%
90.0%
0%
20%
40%
60%
80%
100%
120%
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Core Measure – Venous Thromboembolism (VTE) Prevention
Stroger Provident Goal Source: Quality Dept.
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9.8%
10.7%10.3%
11.0%
16%
15%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
CY18 Q1 CY18 Q2 CY18 Q3 CY18 Q4
30 Day Readmission Rate
IL AVG National AVG
Source: Business Intelligence
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6
5
2 2
1
2 2
0
1 1 1
2
3
18
9
14
12
10
7
6
8
17
8
16
7
0
2
4
6
8
10
12
14
16
18
20
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Hospital Acquired Conditions
Pressure Injury (Stage III & IV) Falls with Injury Source: Business Intelligence
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1.1
0.5
0.8
1.3
0
0.2
0.4
0.6
0.8
1
1.2
1.4
CY18 Q2 CY18 Q3 CY18 Q4 CY19 Q1
Hospital Acquired Infections
CLABSI CAUTI CDI MRSA
Apr-18
May-18
Jun-18
Jul-18
Aug-18
Sep-18
Oct-18
Nov-18
Dec-18
Jan-19
Feb-19
Mar-19
CLABSI 0 1 0 2 3 0 0 0 2 1 0 4
CAUTI 1 2 1 0 1 0 0 1 3 1 1 1
CDI 6 11 4 5 4 2 10 4 4 6 2 6
MRSA 0 0 0 0 1 0 0 1 0 1 0 1
SIR (Standardized Infection Ratio) is a summary measure which compares the actual number of Healthcare Associated Infections (HAI) in a facility with the baseline data for standard population. SIR > 1.0 indicates more HAIs were observed than predicted, conversely SIR of < 1.0 indicates that fewer HAIs were observed than predicted.
Source: Infection Control Dept.
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84.2%
75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Mea
n S
core
ACHN – Overall Clinic Assessment
ACHN Goal
Source: Press Ganey
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100%
90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
To
p B
ox
Sco
re
Provident – Willingness to Recommend the Hospital
Hospital Goal
Source: Press Ganey
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10
65.1%
90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
To
p B
ox
Sco
re
Stroger – Willingness to Recommend the Hospital
Hospital Goal
Source: Press Ganey
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Cook County Health and Hospitals System Quality and Patient Safety Committee Meeting
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ATTACHMENT #2
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Cook County Health and Hospitals System Quality and Patient Safety Committee Meeting
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ATTACHMENT #3
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Strategic Planning FY2020- 2022Professional Education
John M. O’Brien, M.D.
Chairperson, Department of Professional EducationApril 18, 2019
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Overview of DepartmentProfessional Education
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Overview of Department
Internal Residencies and Fellowships (Employed by Cook County Health- CCH)
External Trainees that Rotate At CCH
Students – Including Medical Students and Allied Health
Academic Library
3
Oversight of Medical Training
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Impact 2020 UpdateStatus and Results• Deliver High Quality Care
• Grow to Serve and Compete
• Foster Fiscal Stewardship
• Invest in Resources
• Leverage Valuables Assets
• Impact Social Determinants
• Advocate for Patients Page 33 of 110Page 33 of 112
Impact 2020
5
Progress and Updates
Focus Area Name Status
Invest in Resources:Enhance medical education by further development of safety culture and reporting
• Implement Clinical Learning Environment Review (CLER) Pathways to Excellence
• Increase Culture of Safety response rate from under 10% to 30%
• Provide safety coaching to at least 50% of leadership
• 2018-2019: Increase safety event reporting from 350 to 800
Complete
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Increasing Safety Event Reporting
6
electronic Medical Event Reporting System (eMERS)
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Impact 2020
7
Progress and Updates
Focus Area Name Status
Invest In Resources:Recruit, hire and retain the best employees who are committed to the CCH mission
Develop and administer post-match survey to be sent to all local students that rotated here-to determine what factors led to choosing another program over CCH.
Complete
Identify clinical areas of need (positions unfilled/positions not filled with superior clinical faculty).
In Progress
Implement institutional exit interviews to include questions about why graduate chooses to leave.
Complete
Annually review alignment of program's educational goals with those of the institution and identify opportunities to improvealignment.
In Progress
Develop a metric that measures success of retaining superior members of a residency/fellowship class based on open positions.
In ProgressPage 36 of 110Page 36 of 112
History of Medical Training in the U.S.
• 1765 - 1st Med School
• 1876 - Association of American Medical Colleges
• 1910- Flexner Report
• 1920’s-Internship and Residency following Med School became standard
• 1965 – Medicare Established: payments to hospitals to subsidize resident education
• 1996 – Medicare Caps Residency Slots
• 1999 – To Err Is Human
• 2002 – ACGME institutes duty hour regulations (80 hours per week, 30 hour call, one day off per
week)
• 2014 – ACGME establishes the CLER Program
8
Learning By Doing (Service >Education)
ACGME-Accreditation Council for Graduate Medical EducationPage 37 of 110Page 37 of 112
Moving Away From A Service-Based Residency Model
• Still facilitate a cost effective model of 24/7 care of acutely ill patients
• Are associated with safer care and better outcomes1
• Help to attract attending physicians
• Provide valuable feedback that can improve hospital performance
• Improve physician hiring decisions (when familiar with graduate’s skills)
• Reduce recruiting costs
• Improve retention of newly hired attending physicians
1 McAlister, Finlay et. al. Post Discharge Outcomes in Heart Failure are Better for Teaching Hospitals
and Weekday Discharges; Circ Heart Failure 2013; 6:922-929
9
Generally Accepted Benefits of Residencies/Fellowships
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Final Deliverable
Recruit Outstanding Medical Students
Train Them In High Quality Residencies/Fellowships
Successfully Recruit and Retain the Best to Stay at CCH
10
Retention of Superior Graduates
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Recruit Outstanding Medical Students
There are not enough American Medical Graduates (AMGs) to Fill All of the Residency Slots in the US
(12,500 of 30,000 1st Year slots filled by IMGs)
• ~25% of All Residents and ~30% of Fellows in the US are International Medical Graduates (IMGs)
• IMGs pass boards at nearly the same rate as AMGs
• ~25% of all practicing physicians in the US are IMGs including1:
• 40% of Primary Care Physicians
• >50% of those practicing Geriatric Care
• 2/3 of all physicians practicing in Non-Urban Medically Underserved Areas
11
International Vs. American Medical Graduates?
1 Association of American Medical Colleges; 2015 State Physician Workforce Data Book
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Recruit Outstanding Medical Students
Program American Medical
Graduates
U.S. International
Medical Graduates
International Medical
Graduates
Anesthesia 2 (0) 4 (3) 3 (6)
Emergency Medicine
17 (17) 0 (0) 0 (0)
Family Medicine 11 (11) 0 (1) 1 (0)
Internal Medicine 4 (3) 3 (0) 32 (39)
Primary Care 5 (5) 0 (0) 0 (0)
Radiology 4 (4) 0 (0) 0 (0)
TOTAL 43 (39) 7 (4) 36 (45)
12
Matches to first year training slots, Last Two Years 2019 (2018)
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Origin of Medical Students for the Incoming Class
13
Contribution of Local Schools
Other , 35
UIC, 3
Rosalind Franklin, 3
Midwestern, 3
Loyola, 2
Rush, 2A.T. Still, 2
Other UIC Rosalind Franklin Midwestern Loyola Rush A.T. Still
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Measurement of the Quality of the Programs
Accredited
Internal Medicine (120)
Emergency Medicine (68)
Anesthesiology (36)
Family Medicine (36)
Radiology- Diagnostic (16)
Dermatology (12)
Ophthalmology (12)
Primary Care (Integrated) (12)
Pediatrics (10)
Urology (10)
Pulmonary /Critical Care Medicine (9)
Cardiovascular Disease (9)
Gastroenterology (9)
Oral Surgery (8)
Hematology-Oncology (7)
Neonatal Perinatal Medicine (6)
Preventive Medicine (4)
Pain Medicine (4)
Palliative Care/Hospice (3)
Pharmacy (3)
Surgical Critical Care (3)
Colon/Rectal Surgery (3)
Toxicology (Integrated) (2)
Neurosurgery (2)
Free-Standing Programs Without Accrediting Bodies
Burn (2)
Trauma (2)
Retinal Disease (2)
Simulation Laboratory (2)
Corneal Disease (1)
Total for all Programs=416
14
( ) = Full Time Equivalent Trainees/program
Train In High Quality Residencies
5 Citations
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Train In High Quality Residencies
Residency Took Boards Passed Boards
Anesthesiology 100% 80%
Dermatology 100% 100%
Emergency Medicine 100% 94%
Family Medicine 97% 97%
Internal Medicine 100% 95%
Ophthalmology 89% 89%
Pediatrics 100% 92%
Radiology 100% 100%
Urology 100% 100%
15
Board Passage - Residents Since 2016
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Train In High Quality Fellowships
Residency Took Boards Passed Boards
Cardiovascular Disease 100% 100%
Colon and Rectal Surgery 100% 78%
Gastroenterology 100% 100%
Hematology/Oncology 86% 86%
Neonatal-Perinatal Medicine 100% 100%
Pain Medicine 91% 91%
Palliative Medicine 78% 78%
Preventive Medicine 100% 100%
Pulmonary/Critical Care 100% 100%
Surgical Critical Care 100% 100%
Toxicology 87.5% 87.5%
16
Board Passage- Fellows Since 2016
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Retention of Graduates
17
Composition of Departments – Percentage of Total Staff that Trained at CCH
0%
10%
20%
30%
40%
50%
60%
70%
Anesthesia CorrectionalHealth
EmergencyMedicine
FamilyMedicine
InternalMedicine
OB/Gyne Pediatrics Radiology Surgery Trauma
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Retention of Graduates in the Last Three Years
18
Percent of Physicians Hired Since 2015 That Trained at CCH
0%
10%
20%
30%
40%
50%
60%
70%
80%
Anesthesia CorrectionalHealth
EmergencyMedicine
FamilyMedicine
InternalMedicine
OB/Gyne Pediatrics Radiology Surgery Trauma
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Rotator Programs
Integrated
Adolescent Medicine (1)
Allergy (1)
General Surgery (23)
Endocrinology (3)
Infectious Disease (5)
Neurology (2)
OB/GYN (16)
Rheumatology (2)
Neurosurgery (2.5)
Not Integrated
Orthopedics (7.5)
ENT (7)
Pathology (3)
Nephrology (2)
Trauma (8)
19
Provide Residents With Reduced Overhead
( ) = FTE Trainees/yr
Cost = $4,460,328
Cost = $2,225,684
Claim these on Medicare
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Impact 2020
20
Progress and Updates
Focus Area Name Status
LeverageValuable Assets
Demonstrate value of undergraduate and graduate medical education and academic affiliations to the organization by analysis of costs, returns, pipeline to workforce and facilitation of CCH mission
In Progress
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Cost Analysis
Budgeted Items with 12 Residents Cost
Resident Salary and Benefits (12+Chf)
$978,182
Required Faculty Salary (0.62 FTE) $170,357
Program Dir. And APD (0.9 FTE) $188,525
Admin Staff (0.5 FTE) $43,344
"Other" costs $25,030
GME Reimbursement -$240,000
Total Cost of Residency $1,165,437
21
Pediatrics
Budgeted Items Without Any Residents
FTE Cost
Extenders 7.0 $945,000
Inpatient Attendings 4.0 $982,000
Outpatient Attendings
0.2 $49,140
Recruiting $56,000
Total $2,032,140
35% of the activities can be
done by an extender & 20%
need a doctor
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FY2020-2022The Future
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SWOT AnalysisStrengths, Weaknesses, Opportunities and Threats
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SWOT Analysis
Item
• Item
24
Strengths• Mission driven• Patient mix• Autonomy• Dedicated teachers
Weaknesses• Not a university• Service vs. education• Inefficiencies in care related to social
determinants of health• Institutional inertia – reluctance to change• Work in siloes• Current GME reimbursement based on
Medicare patient load
Opportunities• New program requirements by ACGME• High Reliability Training• CLER visits• Millennials• Immigration• Increasing public data
Threats• Funding• Health care changes (dismantling of the ACA)• Competition for patients• Immigration
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FY2020-2022Strategic Planning Recommendations
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Deliver High Quality Care
Deliver High Quality Care
• Introduce Patient Quality and Safety Training for all new employees through a two-step approach.
26
FY2020-2022 Strategic Planning Recommendations
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Grow to Serve and Compete
Leverage Valuable Assets
• Use the analysis of costs, returns, pipeline and current patient care needs to workforce and
facilitation of CCH mission to identify the optimal size of each residency, fellowship, and rotator
group
27
FY2020-2022 Strategic Planning Recommendations
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Foster Fiscal Stewardship
Deliver High Quality Care
• Design and implement a multidisciplinary simulation-based exercise to improve communication among all of
the patient care team as measured by top-box scores on the Patient Satisfaction survey.
28
FY2020-2022 Strategic Planning Recommendations
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Invest in Resources
Invest In Resources
• Using publicly available data and National Provider Identifiers (NPI), provide another metric for our training
programs via the comparison of CCH graduates to all providers in key areas including length of stay, opioid
prescription and adherence to best practices.
29
FY2020-2022 Strategic Planning Recommendations
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Thank you.
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Action Item
Program FTE residents Contract Length-Yrs Max. Ann. Reimbursed
NORTHWESTERN/MCGAW
OB/GYNE 15 3 $1,304,723
Otolaryngology 4 3 $361,405
Orthopedics 4 3 $356,120
Trauma 2 3 $179,460
Urology 1 3 $93,939UNIVERSITY OF ILLINOIS-CHICAGO
Pediatrics 1.5 1 $120,064
Agreements for Review and Approval
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Action Item
Program FTE residents Contract Length-Yrs Max. Ann. Reimbursed
RUSH
Neurosurgery 2.8 1 $171,622
Franciscan St. James
Orthopedics 2 1 $185,995
Agreements for Review and Approval
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Cook County Health and Hospitals System Quality and Patient Safety Committee Meeting
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ATTACHMENT #4
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Cook County Health and Hospitals System Quality and Patient Safety Committee Meeting
April 18, 2019
ATTACHMENT #5
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Strategic Planning FY2020- 2022Ambulatory Health Centers & Maternal Child HealthIliana A. Mora
COO, Ambulatory Services
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Overview of AmbulatoryHealth Centers
Maternal Child Care
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Overview of Ambulatory Health Centers
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Overview of Ambulatory Health Centers
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FY2018 Overview of CCH Patients Demographics
5
11%
38%38%
9%4%
Age Groups
0 - 18
19 - 44
45 - 64
65 - 74
75 +
51%
2%3%
0%
12%
32%
RaceAfrican-American/Black
AmericanIndian/Native Alaskan
Asian
NativeHawaiian/PacificIslanderOther/UTD
White
32%
67%
1%
Ethnicity
Hispanic/Latino/Spanish Origin
Non-Hispanic/Latino/Spanish Origin
Unknown
52%48%
Gender
Female
Male
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Provider Risk Score*
All CountyCare Providers 1.14
Cook County Health 1.41
Overview of Ambulatory Health Centers
Acuity of our CountyCare patients (Cook County Health data compared to others)
Source: 2018 IL Medicaid Data. * Risk score based on diagnosis codes, national drug codes derived from pharmacy claims, and medical claims
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FY2018 Primary Care Visits
7
Campus Clinic FY2018 FY2017
Ambulatory Health Centers
Prieto 16,716 19,399
Near South 14,438 13,682
Logan 14,672 13,382
Oak Forest 13,747 13,500
Austin 12,936 12,951
Englewood12,036 12,003
Vista 11,214 8,927
Cicero 10,938 11,354
Woodlawn 10,153 9,185
Robbins 9,926 10,005
Cottage Grove 9,536 9,625
Morton East 893 974
Children’s Advocacy 533 541
Stroger
General Medicine Clinic 44,745 46,908
Ruth M. Rothstein CORE Center 13,724 14,521
Stroger Pediatrics 4,283 4,410
Provident Sengstacke16,662 16,659
Total217,152 218,026
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2018 – Other Visits Totals
Prenatal 10,178
HIV/ AIDS Visits 18,821
Behavioral Health 29,277
Dental 9,558
TOTAL 67,834
Overview of Ambulatory Health CentersOur Services
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FY2018 Specialty/Diagnostic/Procedure Visit Volume
9
Campus Clinic FY2018 FY2017
AmbulatoryHealth Centers
Austin- OBGYN/Behavioral Health* 5,848 1,747
Cicero- OBGYN/Family Planning 982 1,266
Logan Square- OBGYN 925 802
Oak Forest 29,073 28,322
Oral Health 5,039 4,709
Total 41,867 36,846
*Behavioral Health services started at Austin during FY2018
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Impact 2020 UpdateStatus and Results• Deliver High Quality Care
• Grow to Serve and Compete
• Foster Fiscal Stewardship
• Invest in Resources
• Leverage Valuables Assets
• Impact Social Determinants
• Advocate for patients Page 73 of 110Page 75 of 112
Impact 2020
11
Progress and Updates
Focus Area Name Status
Deliver High Quality Care Logan Replacement Health Center: make investments in outpatient facilities, leveraging CCDPH data on population health and changes in the local health care environment impacting availability of primary care or specialty services. 2017: Open replacement Logan Square Health Center
In progress
Deliver High Quality Care Implement extended hours, requires impact bargaining: provide a health care experience that is patient-centered and convenient, including extended weekend and evening hours, patient support center, pre-registration, parking. 2017: Establish extended hours at all health centers.
In progress
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Impact 2020
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Progress and Updates
Focus Area Name Status
Deliver High Quality Care Continued focus on strengthening PCMH. 2017-2019: Attain year-over-year increases in primary care patients empaneled at community health centers and patient satisfaction scores. 2017-2019: Implement telephone management phone tree at all primary care sites.
In progress
Deliver High Quality Care Decrease ambulatory dwell time through process improvements. 2017-2019: Reduce wait times year-over-year.
In progress
Grow and Compete Increase of primary care patients by 10%. In progress
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FY2020-2022The Future
Environmental Scan of Market, Best Practices and Trends
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Environmental Scan of Market, Best Practices and Trends
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• Our Competition
• Our Customer
• Our Funding Sources
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Environmental Scan of Market, Best Practices and Trends
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Our Competition
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Environmental Scan of Market, Best Practices and Trends
IN COOK COUNTY
• FQHC Health Centers 207
• FQHC Look-A-Like Health Centers 10
• Ryan White HIV/AIDS Providers 61
Total Federal Grant Funding in 2017:
• FQHC’s: $197M
• Ryan White HIV/AIDS: 41.9M
(include Core Center)
Services:
• Primary Care
• Maternal Child Care
16
Federally Qualified Health Centers (FQHCs) & Ryan White HIV/AIDS Providers
Cook County Health
14 Health Center Locations
Source: US Dept. of Health & Human Services, Bureau of Primary Health Care, UDS MAPPER, 2017
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Environmental Scan of Market, Best Practices and Trends
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Federally Qualified Health Centers (FQHCs) Continuously
Opening New Health Centers
&
Renovating Health Centers
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Environmental Scan of Market, Best Practices and Trends
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Strong Branding: Federally Qualified Health Centers (FQHCs)
Billboards
Social Media
Branded Health CenterWebsites
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Environmental Scan of Market, Best Practices and Trends
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Mergers & Acquisitions: Federally Qualified Health Centers (FQHCs)
• Acquiring free clinics
• Acquiring hospital medical practices
• Acquiring residency training sites
• Potential for future mergers and acquisitions among FQHCs
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Environmental Scan of Market, Best Practices and Trends
• Free Clinics
20
Other Community Providers
• Specialized
Providers
• Individual Pediatric & Prenatal
Medical Practices
• Medical Practices of Health Systems
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Environmental Scan of Market, Best Practices and Trends
• Safety-Net Health Systems
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Prenatal / Delivery
• All Other Health Systems
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Environmental Scan of Market, Best Practices and Trends
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Our Customer
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Environmental Scan of Market, Best Practices and Trends
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Source: US Dept. of Health & Human Services, Bureau of Primary Health Care, UDS MAPPER
Total Population of Cook County
2012-2016 5,696,008
Total Population Low Income of Cook County 1,903,001
Total Patients Served by Federally Health Centers
(Low Income)
732,144
Total Patients Not Served (Low Income) 1,117,857
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Environmental Scan of Market, Best Practices and Trends
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City of Chicago Birth Rate
Source: Illinois Department of Public Health, Vital Statistics
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Environmental Scan of Market, Best Practices and Trends
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City of Chicago Fertility Rate
Source: Illinois Department of Public Health, Vital Statistics
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Environmental Scan of Market, Best Practices and Trends
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City of Chicago Preterm Birth
Source: Illinois Department of Public Health, Vital Statistics
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Environmental Scan of Market, Best Practices and Trends
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City of Chicago Low Birthweight
Source: Illinois Department of Public Health, Vital Statistics
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Environmental Scan of Market, Best Practices and Trends
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• The infant mortality rate has decreased, but significant disparities exist based on race / ethnicity.
• The infant mortality rate for infants born to Non-Hispanic black women is two to three times as high as the infant mortality
rate of infants born to Non-Hispanic white women.
City of Chicago Infant Mortality Rate
Source: Illinois Department of Public Health, Vital Statistics
per 1,000 births per 1,000 births
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Environmental Scan of Market, Best Practices and Trends
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• Infants at higher risk for infant mortality include those born to:
• Non-Hispanic black women
• Younger mothers
• Unmarried women
• Women with a high school education or less
• U.S.-born women (vs. foreign-born)
• Women covered by Medicaid
• Women with three or more previous births
• Residents of the city of Chicago
• Women with pregnancy-related hypertension (high blood pressure) or eclampsia
• Women who had no prenatal care
Infant Mortality Rate
Source: Illinois Department of Public Health, Vital Statistics
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Environmental Scan of Market, Best Practices and Trends
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Our Funding Sources
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Oct. 2018 Nov. 2018 % Change Dec. 2018 % Change
Cook County 1,413,665 1,386,693 1.91% 1,353,809 2.37%
Other 1,617,146 1,591,627 1.58% 1,556,278 2.22%
Environmental Scan of Market, Best Practices, Trends
• Steady decreases in Medicaid membership due to loss of coverage across fee-for-service and managed
care.
• Cook County Medicaid beneficiaries are losing coverage at a higher rate than those in other IL counties.
Possible cause of loss of Medicaid coverage is current redetermination policy.
Reduction in Medicaid coverage across Illinois
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Environmental Scan of Market, Best Practices, Trends
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Consolidation of Medicaid Managed Care Plans
*CountyCare
Meridian (a WellCare Co.)
Blue Cross Blue Shield
IlliniCare
Molina
Next Level
Today: 6 Medicaid Managed Care Plans Future:
May experience more consolidation
Continue pay for performance contracts
Compliance / Regulatory
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SWOT AnalysisStrengths, Weaknesses, Opportunities and Threats
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Strengths• Health Centers are part of Health System
• Hospital • Ancillary Services • Specialty Care • Care coordination • Health Plan • Support Departments (project mgmt.,
regulatory, etc.)• Mature integrated Electronic Health Record &
Data Systems• New health centers• Staff commitment to serving Cook County’s
vulnerable and underserved populations
Weaknesses• Lack of full integration with Health System• Lack of managed care knowledge and
infrastructure • Lack of operational efficiency knowledge • Lack of standardization across health centers• Lack of performance management knowledge• Limited Branding: marketing and
communication• Lengthy hiring process• Distant community relationships • Limited multi-lingual / cultural staff competency • Early stage of culture of excellence
Opportunities• Optimize integration of services across Cook
County Health• Improve patient access and productivity • Increase specialty care and imaging services• Performance in managed care contracts• Prenatal and pediatric patient base• Deepen community roots and connections • Diversification of talent • Partnerships with Federally Qualified Health
Centers
Threats• Federally Qualified Health Centers
• Predominant market presence in primary care and maternal child health
• Better service and patient experience• New state of the art facilities • Strong community brand• Access to federal operating and capital
funds • Growing uninsured
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FY2020-2022Ambulatory Health Centers
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Deliver High Quality Care
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FY2020-2022 Strategic Planning Recommendations
• Re-build prenatal program • prenatal medical care• prenatal education • support staffing
• Improve preventive screenings• depression, smoking, partner violence, etc.
• Optimize link between health center and Stroger Hospital Labor & Delivery
• Improve linkage to Women, Infants and Children (WIC) and social supports
• Develop child development services
• Improve quality metrics
Primary Care Maternal Child Health
• Increase Access
• Improve Quality of Chronic Disease Management
• Optimize Operations Management
• Strengthen Leadership
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Grow to Serve and Compete
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FY2020-2022 Strategic Planning Recommendations
• Provide More Care• Primary Care• Specialty Care• Imaging Services• Hours of Operation• Residency Program
• Serve More Communities• Location Analysis• Service Analysis• Physical Site Evaluation
• Provide Maternal Child Services• FQHC Partnership • Investment in Stroger Labor & Delivery
• Grow Community Partnerships• Community Organizations• Schools• Churches
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Align Clinical Operations to meet Medicaid
Managed Care pay for performance measures
Efficient integration of financial counselors into
clinic flow
FY2020-2022 Strategic Planning Recommendations
Partner with Program Services & Innovation, to
apply for federal, state and private grants to
support mission
Foster Fiscal Stewardship
• Increase Medicaid Managed Care Competency
• Increase Benefits Enrollment
• Expand Grant Funding
• Launch Cost Containment Strategies
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FY2020-2022 Strategic Planning Recommendations
Invest in Resources / Leverage Valuable Assets
• Strengthen Brand
• Become Prenatal and Maternity Care Provider of Choice
• Renovate Health Centers
• Invest in People & Information Technology
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Focused strategy to hire staff that is culturally and linguistically reflective of
communities we serve
Evaluate and implement practices that are culturally and linguistically sensitive,
to yield better health outcomes
FY2020-2022 Strategic Planning Recommendations
Develop culturally tailored interventions and
programming to reduce racial and ethnic
disparities in health
Impact Social Determinants/Advocate for Patients
• Hiring Reflects our Patients & Communities
• Shape our Health Centers to be Culturally & Linguistically Sensitive
• Launch Culturally Tailored Health Promotion Programming and Interventions
• Engage More Patients through Community Advisory Councils
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Thank you.
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APPENDIX
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Deliver High Quality Care
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FY2020-2022 Strategic Planning Recommendations
Appointment AvailabilityShow Rate
Slot Utilization Phone AccessVirtual VisitsPortal Access
STRENGTHEN LEADERSHIP
IMPROVE QUALITY OF CHRONIC
DISEASE MANAGEMENT
OPTIMIZE OPERATIONS MANAGEMENT
INCREASE ACCESS
Diabetic CareChildhood ImmunizationsBehavioral Health Screenings
Entry into Prenatal Care
Cycle TimePatient Panel Management
Competency of StaffCross-Site Staff DeploymentCare Coordination Integration
Optimize Decision-Support Health IT Tools
Clinic Leadership Development
Matrix ReportingTop Talent Recruitment
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Primary CareSpecialty Care
Imaging ServicesHours of OperationResidency Program
GROW COMMUITY PARTNERSHIPS
SERVE MORE COMMUNITIES
PROVIDE MORE MATERNAL CHILD
SERVICESPROVIDE MORE CARE
Location AnalysisService Analysis
Physical Site Evaluation
Grow to Serve and CompeteFY2020-2022 Strategic Planning Recommendations
FQHC PartnershipLabor & Delivery
Investment
Community Organizations Schools
Churches
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Align Clinical Operations to meet Medicaid
Managed Care pay for performance measures
COST CONTAINMENTBENEFITS
ENROLLMENTGRANT FUNDING
MEDICAID MANAGED CARE
Efficient integration of financial counselors into
clinic flow
Develop strategies to contain temporary staffing costs and
overtime use, and partner with HR to quicken the
hiring process
FY2020-2022 Strategic Planning Recommendations
Partner with Program Services & Innovation, to
apply for federal, state and private grants to
support mission
Foster Fiscal Stewardship
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Health Center Branding Campaign
INVEST INPEOPLE & IT
BECEOME PRENATAL CARE AND DELIVERY PROVIDER OF
CHOICE
RENOVATE HEALTH CENTERS
STRENGTHENBRAND
Prenatal Education and Programming
Stroger Labor & Delivery
Stroger Post-Partum
People: Quality Improvement & Process
Improvement
IT: Data Sharing Interfaces & Decision
Support Tools
FY2020-2022 Strategic Planning Recommendations
Existing Site Renovations
Relocate SitesNew Sites
Invest in Resources / Leverage Valuable Assets
Health Center Branding Campaign
BECOMEMATERNITY CARE
PROVIDER OF CHOICE
STRENGTHENBRAND
Prenatal ProgrammingUpgrade Labor and Delivery
& Post-PartumStrengthen Maternal Fetal
Medicine Division
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Focused strategy to hire staff that is culturally and linguistically reflective of
communities we serve
ENGAGING PATIENTSSHAPE OUR PRACTICES
LAUNCH HEALTH PROMOTION
HIRING REFLECTS OUR PATIENTS
Evaluate and implement practices that are culturally and linguistically sensitive,
to yield better health outcomes
Continue to develop Community Advisory
Councils and other means to engage patient input on
care delivery
FY2020-2022 Strategic Planning Recommendations
Develop culturally tailored interventions and
programming to reduce racial and ethnic
disparities in health
Impact Social Determinants/Advocate for Patients
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